POS0374 HOW WELL DO EULAR/ASAS-EULAR AND NATIONAL TREATMENT RECOMMENDATIONS FOR PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS ALIGN? IS IT TIME FOR AN UPDATE OF NATIONAL TREATMENT RECOMMENDATIONS?
Authors: B. Michelsen, M. J. Nissen, A. Ciurea, B. Moeller, L. Midtbøll Ørnbjerg, J. Zavada, B. Glintborg, A. Macdonald, K. Laas, D. Nordström, B. Gudbjornsson, F. Iannone, P. Hellamand, T. K. Kvien, A. M. Rodrigues, C. Codreanu, Z. Rotar, I. Castrejon, J. K. Wallman, J. Vencovský, A. G. Loft, M. Heddle, S. Vorobjov, A. M. Hokkanen, G. Gröndal, M. Sebastiani, M. G. H. Van de Sande, E. Kristianslund, M. J. Santos, C. Mogosan, M. Tomsic, F. Diaz-Gonzalez, D. DI Giuseppe, M. Østergaard, M. L. Hetland
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> National treatment recommendations are often used to optimize patient care and may differ from international recommendations. Although such potential heterogeneity may affect outcomes, mapping of these differences across European countries was last performed more than a decade ago for axial spondyloarthritis (axSpA) and has never been undertaken in psoriatic arthritis (PsA).<sup>[1]</sup> <h3>Objectives</h3> To assess differences and similarities between the EULAR and ASAS-EULAR recommendations for the treatment of patients with PsA and axSpA, respectively, versus national PsA and axSpA treatment recommendations across Europe. <h3>Methods</h3> Rheumatologists from 15 European countries (Czech Republic, Denmark, Estonia, Finland, Iceland, Italy, Netherlands, Norway, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom) compared the most recent national treatment recommendations for PsA and axSpA with the "EULAR recommendations for the management of PsA with pharmacological therapies: 2019 update"<sup>[2]</sup> and the "2016 update of the ASAS-EULAR recommendations for axSpA"<sup>[3]</sup>, in an online survey conducted between October 2021 and April 2022. The study was an initiative of the European Spondyloarthritis Research Collaboration Network (EuroSpA RCN).<sup>[4]</sup> <h3>Results</h3> Three countries (Czech Republic, Netherlands, and Spain) followed all EULAR recommendations for treating patients with PsA and four countries (Czech Republic, Italy, Spain, and Switzerland) all ASAS-EULAR recommendations for axSpA. A total of 4/15 countries had no national treatment recommendations for PsA or axSpA, but had other rules or regulations to follow, for which the comparisons in this study were then performed. The Netherlands had national treatment recommendations for axSpA, but not yet for PsA, for which EULAR recommendations were followed. In six countries, the national treatment recommendations for PsA predated the 2019 EULAR recommendations and in one country the national treatment recommendations for axSpA predated the 2016 ASAS-EULAR recommendations. More differences were seen between the EULAR and the national treatment recommendations for PsA than between the ASAS-EULAR and the national treatment recommendations for axSpA (Figure 1). Discrepancies between international and national treatment recommendations included: Entry criteria for start of a biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) varied and were the most stringent in Romania, where DAPSA&gt;28 for PsA and BASDAI&gt;6 and ASDAS≥2.5 for axSpA were required for the start of a bDMARD. Regarding PsA, in two countries (Finland and Switzerland) a conventional synthetic DMARD should be initiated before a b/tsDMARD including in patients with predominantly enthesal or axial disease. In several countries, no preference for IL17 inhibitors was given for PsA patients with significant skin involvement. The positioning of Janus Kinase inhibitors (JAKi) differed across countries, e.g. in Estonia JAKi were indicated after failure of two tumor necrosis factor inhibitors and in Romania JAKi were positioned at the same level as bDMARDs. Phosphodiesterase-4 inhibitors were not in use or not reimbursed in most countries. Analgesics were not specifically mentioned in several of the national treatment recommendations. <h3>Conclusion</h3> Only a few European countries incorporated all EULAR and ASAS/EULAR treatment recommendations in their national recommendations. The potential impact of this on access to b/tsDMARD treatments needs to be further explored. <h3>References</h3> [1]Van den Berg et al. Rheumatology (Oxford) 2011;50:2270-7 [2]Gossec L et al. Ann Rheum Dis 2020;79:700-12. [3]van der Heijde D et al. Ann Rheum Dis 2017;76:978-91. [4]eurospa.eu <h3>Acknowledgements</h3> Novartis Pharma AG for supporting the EuroSpA collaboration. <h3>Disclosure of Interests</h3> Brigitte Michelsen Consultant of: Novartis, Grant/research support from: Novartis (paid to employer), Michael J. Nissen Speakers bureau: Consulting and/or speaking fees from AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Consultant of: Consulting and/or speaking fees from AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Adrian Ciurea Grant/research support from: Novartis, Burkhard Moeller Speakers bureau: Eli-Lilly, Janssen, Novartis, Pfizer, Grant/research support from: Amgen, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Jakub Zavada Speakers bureau: Abbvie, Eli-Lilly, Sandoz, Novartis, Egis, UCB, Consultant of: Abbvie, Eli-Lilly, Sandoz, Novartis, Egis, UCB, Bente Glintborg Grant/research support from: Pfizer, Abbvie, BMS, Alan MacDonald: None declared, Karin Laas Speakers bureau: Consulting and/or speaking fees from Amgen, Johnson and Johnsen, Novartis, Consultant of: Consulting and/or speaking fees from Amgen, Johnson and Johnsen, Novartis, Dan Nordström Speakers bureau: Consulting and/or speaking fees from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: Consulting and/or speaking fees from Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: MSD, Björn Gudbjornsson Speakers bureau: Consulting an/or speaking fees from Novartis and Nordic Pharma, Consultant of: Consulting an/or speaking fees from Novartis and Nordic Pharma, Florenzo Iannone Speakers bureau: Consulting and/or speaking fees from Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: Consulting and/or speaking fees from Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Pasoon Hellamand Grant/research support from: Novartis, Tore K. Kvien Speakers bureau: Grünenthal, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celltrion, Gilead, Novartis, Pfizer, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, BMS, Galapagos, Novartis, Pfizer, UCB, Ana Maria Rodrigues Speakers bureau: Consulting and/or speaking fees from Abbvie, Amgen, Consultant of: Consulting and/or speaking fees from Abbvie, Amgen, Grant/research support from: Novartis, Pfizer, Amgen, Catalin Codreanu Speakers bureau: Speaking or consultant fees from AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Consultant of: Speaking or consultant fees from AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Isabel Castrejon Speakers bureau: Speaker and/or consultant fees from BMS, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, MSD, Pfizer. GSK, Consultant of: Speaker and/or consultant fees from BMS, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, MSD, Pfizer. GSK, Johan K Wallman Speakers bureau: Abbvie, Amgen, Consultant of: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Jiří Vencovský: None declared, Anne Gitte Loft Speakers bureau: Speaking and/or consultant fees from Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: Speaking and/or consultant fees from Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: Novartis, Maureen Heddle: None declared, Sigrid Vorobjov: None declared, Anna-Mari Hokkanen Grant/research support from: MSD, Gerdur Gröndal: None declared, Marco Sebastiani Speakers bureau: Speaker and/or consultant fees from Eli Lilly, Janssen, BMS, Pfizer, Galapagos, Boehringer-Ingelheim, Consultant of: Speaker and/or consultant fees from Eli Lilly, Janssen, BMS, Pfizer, Galapagos, Boehringer-Ingelheim, Grant/research support from: BMS, Marleen G.H. van de Sande Speakers bureau: Research grant and/or consulting fees and/or speaker fees from Eli Lilly, Novartis, UCB, Janssen, Abbvie, Consultant of: Research grant and/or consulting fees, and/or speaker fees from Eli Lilly, Novartis, UCB, Janssen, Abbvie, Grant/research support from: Research grant and/or consulting fees, and/or speaker fees from Eli Lilly, Novartis, UCB, Janssen, Abbvie, Eirik kristianslund: None declared, Maria Jose Santos Speakers bureau: Abbvie, Astra Zeneca, Lilly, Novartis, Pfizer, Corina Mogosan: None declared, Matija Tomsic Speakers bureau: Consulting and/or speaking fees from Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz, Lek, Consultant of: Consulting and/or speaking fees from Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz, Lek, Federico Diaz-Gonzalez: None declared, Daniela Di Giuseppe: None declared, Mikkel Østergaard Speakers bureau: Speaker and/or consulting fees from Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Consultant of: Consulting and/or speaking fees from Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz, Lek, Merete Lund Hetland Speakers bureau: Pfizer, Medac, Sandoz, Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis.